Objective:To analyze the value of Teach-back combined with video education in the perioperative period of primary total knee arthroplasty for patients with knee osteoarthritis.Methods:Eighty patients with knee osteoarthritis who were admitted to Zhuhai Hospital of Guangdong Hospital of Traditional Chinese Medicine from January 2020 to November 2020 and were to be undergone initial total knee arthroplasty were randomly divided into an experiment group and a control group,with 40 casess in each group.Patients in the control group were given the routine publicity and education,and those in the experiment group were given Teach-back combined with video publicity and education.The number of patients in the two groups who mastered the rehabilitation program at different times after surgery,the patient satisfaction at discharge,and the knee joint HSS scores two weeks and one month after surgery were compared.Results:There was a significant difference between the two groups in the number of patients who mastered the rehabilitation program a half day and a day after operation（P ＜ 0.05）.There was a statistically significant difference in patient satisfaction between the two groups（P ＜ 0.05）.Two weeks and one month after operation,there was a statistically significant difference in HSS scores between the two groups（P ＜ 0.05）.Conclusion:The application of Teach-back combined with video publicity and education in functional rehabilitation of total knee arthroplasty for knee osteoarthritis patients can help patients master the rehabilitation program more quickly,improve patient satisfaction,and effectively improve the knee joint function.The program has clear value and is worthy of promotion.

目的:探讨六味地黄丸组方对前交叉韧带损伤(ACL)损伤患者ACL组织转化生长因子-β1(TGF-β1)、骨形态发生蛋白-2(BMP-2)基因表达及ACL重建术后功能康复的影响.方法:选取2021年1月-2021年9月期间在广东省中医院珠海医院骨一科住院的拟行膝关节镜下ACL重建术治疗的ACL损伤患者60例,按随机数字表法分为观察组和对照组,每组30例.观察组术前2周开始口服六味地黄丸组方,且术后继续服用六味地黄丸组方至少1月,对照组不予服用药物.术中采集患者损伤之前交叉韧带组织,实时荧光定量PCR(RT-qPCR)检测韧带组织的TGF-β1和BMP-2基因表达,并对患者进行IKDC评分、Lysholm评分以及安全性评价.结果:观察组TGF-β1基因表达高于对照组,差异有统计学意义(P＜0.05).两组术前IKDC评分和Lysholm评分比较差异均无统计学意义(均P＞0.05).两组IKDC评分和Lysholm评分与治疗时间之间有显著性交互效应(均P＜0.01),两组IKDC评分和Lysholm评分总体均值有显著性差异(均P＜0.01).两组术后1周-术后1月,术后1月-术后3月IKDC评分和Lysholm评分有显著性差异(均P=0.000);与对照组比较,治疗组术后1月、术后3月IKDC评分和Lysholm评分有显著性差异(均P=0.000).两组患者在治疗期间均未发生不良事件.结论:六味地黄丸组方可提高ACL损伤患者腱骨界面处ACL组织TGF-β1基因表达,促进ACL重建术后关节功能康复.

目的:检验MyotonPRO肌肉弹性测试仪测量健康青年人股直肌、股内侧肌及股外侧肌肌肉弹性的复测信度和测试者间信度.方法:本研究纳入了38例健康青年人,采用MyotonPRO评估放松状态下的股直肌、股内侧肌及股外侧肌肌肉弹性,计算组内相关系数(ICC)、绝对信度,两次测量结果绘制成Bland-Altman图并进行系统偏倚分析.结果:复测信度:组内相关系数值介于0.76-0.90,测量标准误(SEM)值介于0.05-0.09,SEM％介于4.63％-7.11％,最小真正改变量(MDC)值介于0.15-0.25,MDC％介于12.83％-19.70％;测试者间信度:ICC值介于0.86-0.97,SEM值介于0.03-0.08之间,SEM％介于3.42-5.84,MDC介于0.09-0.23,MDC％介于9.48％-16.19％.Bland-Altman图形分析显示无系统性误差.结论:MyotonPRO用于健康青年人股直肌、股内侧肌、股外侧肌肌肉弹性测量具有良好的信度,可为临床提供客观依据.

Background: Asymmetrical foot posture and properties alterations of the gastrocnemius muscle (GM) and Achilles tendon (AT) were observed in knee osteoarthritis (KOA). We aimed to investigate the inter-limbs asymmetries in foot posture and the properties of GM and AT and explore the association between them. Methods: A total of 62 subjects with unilateral or bilateral KOA were included in this study: 30 patients with unilateral pain and 32 patients with bilateral pain were assigned to the bilateral group (BG) and unilateral group (UG), respectively. The relatively serious leg (RSL) and relatively moderate leg (RML) were judged according to the severity of symptoms assessed by using visual analogue scale (VAS) motion. Foot posture and asymmetrical foot posture scores were assessed based on Foot Posture index (FPI-6). Subsequently, all the participants received an assessment for properties of GM and AT, including tone/tension (Hz), stiffness (N/m), and elasticity. We calculated the asymmetry index of AT (Asy -AT) in both legs and the difference of muscle properties between medial and lateral gastrocnemius (D-MLG) in the ipsilateral limb. Results: Asymmetry of foot posture was categorized into three types including normal, asymmetry, and severe asymmetry. The percentage of subjects classified as normal was higher in the BG (62.5%) than in the UG (36.67%), p < 0.05. Tension of AT and tone of lateral gastrocnemius (LG) in RSL were higher than those in RML (15.71 ± 0.91 vs. 15.23 ± 1.01; 25.31 ± 2.09 vs. 23.96 ± 2.08, p < 0.01 and p < 0.01, respectively), and stiffness of AT in the RSL was higher than that in RML (676.58 ± 111.45 vs. 625.66 ± 111.19, p < 0.01). Meanwhile, a positive relationship was found between ipsilateral FPI and tone of MG and LG in the left leg (0.246 per degree, 95% CI: −0.001, 0.129; p = 0.054 and 0.293 per degree, 95% CI: −0.014, 0.157; p = 0.021, respectively) and right leg (0.363 per degree, 95% CI: 0.033, 0.146; p = 0.004 and 0.272 per degree, 95% CI: 0.007, −0.144; p = 0.032, respectively). Moreover, a positive link was observed between asymmetrical FPI scores and K/L grade (0.291 per degree, 95% CI: 0.018, 0.216; p = 0.022). Furthermore, a significantly greater Asy-AT(tension) was detected in the UG than that in the BG (UG vs. UG: 8.20 ± 5.09% vs. 5.11 ± 4.72%, p < 0.01). Additionally, an increased asymmetrical FPI score (i.e., more severe asymmetry) was significantly associated with increases in Asy-AT(tension) and Asy-AT(stiffness) (0.42 per degree, 95% CI: 0.533, 1.881; p = 0.001 and 0.369 per degree, 95% CI: 0.596, 2.82; p = 0.003, respectively). Conclusions: The stiffness and tension of AT and the tone of LG in RSL were higher than those in RML in KOA patients, and inter-limbs foot posture and tension of AT were more asymmetrical in unilateral KOA patients compared to patients with bilateral KOA. Notably, foot posture, as an important biomechanical factor, was significantly associated with properties of GM, AT, and K/L grade in KOA patients.

Background: There is increased interest in proprioceptive training for knee osteoarthritis (KOA). However, little consensus supports the effectiveness of this intervention.Objective: This meta-analysis aimed to assess the effects of proprioceptive training on symptoms, function, and proprioception in people with KOA.Methods: The PubMed, Cochrane Library, Web of Science, and EMBASE databases were systematically searched from the inception dates to April 16, 2021 for relevant randomized controlled trials (RCTs). Data were pooled by calculating the standardized mean differences (SMDs) and 95% confidence intervals (CIs). A random-effects model was used for the analyses.Results: A total of 24 RCTs involving 1,275 participants were included in our analysis. This study indicated that compared to no intervention, proprioceptive training significantly improved pain, stiffness, physical function, joint position sense (JPS), muscle strength, mobility, and knee ROM (P < 0.05) in people with KOA. When compared to other non-proprioceptive training, proprioceptive training provided better results in terms of JPS (SMD = −1.28, 95%CI: [−1.64, −0.92], I2 = 0%, P < 0.00001) and mobility (timed walk over spongy surface) (SMD = −0.76, 95%CI: [−1.33, −0.18], I2 = 64%, P = 0.01), and other results are similar. When proprioceptive training plus other non-proprioceptive training compared to other non-proprioceptive training, the two groups showed similar outcomes, but there was a greater improvement for JPS (SMD = −1.54, 95%CI: [−2.74, −0.34], I2 = 79%, P = 0.01), physical function (SMD = −0.34, 95%CI: [−0.56, −0.12], I2 = 0%, P = 0.003), and knee ROM (P < 0.05) in the proprioceptive training plus other non-proprioceptive training group. When proprioceptive training plus conventional physiotherapy compared against conventional physiotherapy, the two groups demonstrated similar outcomes, but there was a significant improvement for JPS (SMD = −0.95, 95%CI: [−1.73, −0.18], I2 = 78%, P = 0.02) in the proprioceptive training plus conventional physiotherapy group.Conclusions: Proprioceptive training is safe and effective in treating KOA. There is some evidence that proprioceptive training combined with general non-proprioceptive training or conventional physiotherapy appears to be more effective and should be considered as part of the rehabilitation program. However, given that the majority of current studies investigated the short-term effect of these proprioceptive training programs, more large-scale and well-designed studies with long-term follow up are needed to determine the long-term effects of these proprioceptive training regimes in KOA.Systematic Review Registration:https://www.crd.york.ac.uk/prospero/#recordDetails, PROSPERO, identifier: CRD42021240587.

Abstract Background: Electroacupuncture is increasingly used in rehabilitation for postoperative cognitive dysfunction (POCD), but relevant evidence remains unclear for patients receiving total knee arthroplasty (TKA). Methods: The databases research of PubMed, EMBASE, CINAHL, and China National Knowledge Infrastructure (CNKI) will be conducted from inception to December 31, 2020. The relevant randomized controlled trials (RCTs) from data will be screened one by one. The remaining studies that meet the inclusion criteria will be extracted and analyzed using RevMan V.5.3 software. Paired 2 reviewers will assess quality of the included studies and publication bias by using the Cochrane Collaboration risk of bias tool, and Egger test and Begg test respectively. And grading of recommendations assessment, development and evaluation (GRADE) will be used to estimate the quality of evidence. Results: In this study, we will analyze the effect of electroacupuncture on Mini-Mental State Examination (MMSE), interleukin 1β (IL-1β), tumor necrosis factor-α (TNF-α), S100-β protein, and adverse events for patients with TKA. Conclusion: Our findings will provide evidence for the effectiveness of electroacupuncture on the treatment and prevention of POCD for TKA patients. Registration number: Available at: https://osf.io/azyt9 (DOI number: 10.17605/OSF.IO/AZYT9).

BACKGROUND:Electroacupuncture is increasingly used in rehabilitation for postoperative cognitive dysfunction (POCD), but relevant evidence remains unclear for patients receiving total knee arthroplasty (TKA). METHODS:The databases research of PubMed, EMBASE, CINAHL, and China National Knowledge Infrastructure (CNKI) will be conducted from inception to December 31, 2020. The relevant randomized controlled trials (RCTs) from data will be screened one by one. The remaining studies that meet the inclusion criteria will be extracted and analyzed using RevMan V.5.3 software. Paired 2 reviewers will assess quality of the included studies and publication bias by using the Cochrane Collaboration risk of bias tool, and Egger test and Begg test respectively. And grading of recommendations assessment, development and evaluation (GRADE) will be used to estimate the quality of evidence. RESULTS:In this study, we will analyze the effect of electroacupuncture on Mini-Mental State Examination (MMSE), interleukin 1β (IL-1β), tumor necrosis factor-α (TNF-α), S100-β protein, and adverse events for patients with TKA. CONCLUSION:Our findings will provide evidence for the effectiveness of electroacupuncture on the treatment and prevention of POCD for TKA patients. REGISTRATION NUMBER:Available at: https://osf.io/azyt9 (DOI number: 10.17605/OSF.IO/AZYT9).

Objective: The benefits of Pilates for blood glucose and lipids remain unclear. The purpose of this study was to examine the effect of Pilates on their levels.Methods: Searches were conducted in five databases to identify relevant articles published until October 29, 2020. Paired reviewers independently screened the articles and extracted data from each included study. Meta-analysis was performed to assess the effects of Pilates on blood glucose and lipids. Subgroup analyses and sensitivity analyses were conducted to explore heterogeneity.Results: According to the inclusion and exclusion criteria, 15 randomized controlled trials (RCTs) comprising 587 participants were included in the study. Overall, the Pilates group (PG) had a significantly greater reduction in post-prandial blood glucose than the control group (CG) (MD = -22.25 mg/dL, 95% CI: [-28.34, 16.17] mg/dL, P < 0.00001, I-2 = 0%); glycated hemoglobin (HbA1c) (MD = -0.78%, 95% CI: [-1.13, -0.42]%, P < 0.0001, I-2 = 88%); total cholesterol (TC) (MD = -20.90 mg/dL, 95% CI: [-37.21, -4.60] mg/dL, P = 0.01, I-2 = 84%); triglycerides (TG) (MD = -12.59 mg/dL, 95% CI: [-19.88, -5.29] mg/dL, P = 0.0007, I-2 = 86%); and low density lipoprotein cholesterol (LDL-C) (MD = -12.39 mg/dL, 95% CI: [-16.82, -7.95] mg/dL, P < 0.00001, I-2 = 45%) compared to CG, whereas no significant difference was detected between the two groups in fasting blood glucose (MD = -7.04 mg/dL, 95% CI: [-17.26, 3.17] mg/dL, P = 0.18, I-2 = 93%), insulin (MD = -1.44 mu U/mL, 95% CI: [-4.30, 1.41] mu U/mL, P = 0.32, I-2 = 0%); and high density lipoprotein cholesterol (HDL-C) (MD = -2.68 mg/dL, 95% CI: [-9.03, 3.67] mg/dL, P = 0.41, I-2 = 89%). However, by subgroup analysis, we found that compared to the CG, PG showed no significant improvement in blood glucose and lipids levels for non-diabetics, while it presented a significantly greater decrease in post-prandial blood glucose, TC, TG, and LDL-C for diabetic patients. Notably, for diabetic patients, Pilates and medication treatments showed no significant reduction in fasting blood glucose (MD = -7.00 mg/dL, 95% CI: [-26.06, 12.06] mg/dL, P = 0.40) and HbA1c (MD = -0.23%, 95% CI: [-0.58, 0.13]%, P = 0.21, I-2 = 0%) than medications treatment used alone, and Pilates combined with medications and dietary treatments presented no significant improvement in fasting blood glucose than a combination of medications and dietary treatments (MD = -10.90 mg/dL, 95% CI: [-32.35, 10.54] mg/dL, P = 0.32, I-2 = 94%).Conclusions: Overall, Pilates could improve post-prandial blood glucose, fasting blood glucose, HbA1c, TG, TC, and LDL-C for diabetic patients, which could be influenced by its duration and intensity. Moreover, it had no significant effect on blood glucose and lipids for non-diabetic individuals. However, Pilates, as an adjunctive treatment to medications was not superior to medications used alone in lowering fasting blood glucose and HbA1c. Furthermore, Pilates combined with medications and dietary treatments showed no significant improvement in fasting blood glucose, whereas it had a greater reduction in post-prandial blood glucose and HbA1c for diabetic patients.

There is limited research on the changes of biomechanical characteristics of the lumbar extensor myofascia in elderly patients with chronic low back pain. This study aimed to compare the biomechanical properties of the lumbar extensor myofascia in elderly patients with chronic low back pain and healthy people when resting and to analyze the relationship between the Japanese Orthopedic Association (JOA) score, visual analog scale (VAS) score, Cobb angle, and disease course and the biomechanical characteristics of the lumbar extensor myofascia. This case-control study included 40 elderly patients with chronic low back pain and 40 healthy volunteers. MyotonPRO was used to measure the biomechanical properties of the bilateral lumbar extensor myofascia (at L3/L4 level) in all participants, and the reliability of the MyotonPRO test was measured. Cobb angle was measured from lumbar computed tomography or magnetic resonance imaging data. JOA and VAS scores were used to evaluate lumbar function and pain. We found that muscle tone, stiffness, and elasticity of the left and right lumbar extensor myofascia in patients with chronic low back pain were very reliable among different operators. The average lumbar extensor muscle tone and stiffness were significantly higher in patients with chronic low back pain than those in healthy controls. The average elasticity of the lumbar extensor myofascia of patients with chronic low back pain was significantly lower than that of the healthy controls. The JOA score was negatively correlated, while the VAS score was positively correlated with the mean values of tone, stiffness, and elasticity of the bilateral lumbar extensor myofascia (logarithmic decrement). Disease course had no significant correlation with muscle tone, stiffness, and elasticity of the lumbar extensor myofascia. No significant correlation was found between Cobb angle and muscle tone, stiffness, and elasticity of the lumbar extensor myofascia in either group.

Background: Primary osteoporosis (POP) is one of the most common orthopedic diseases with a high risk of fracture. Effective treatment of POP is of great significance to reduce the rate of disability and improve the quality of life. Bushen qianggu (BSQG) is a classical method of TCM in treating POP. However, there is no systematic review related to BSQG for POP. The purpose of this study is to provide a comprehensive and reliable evaluation of the clinical evidence of BSQG in the treatment of POP. Methods and analysis: Relevant randomized controlled trial literature evaluating the effect of BSQG on patients with POP will be obtained by searching the PubMed, Embase, MEDLINE, Cochrane Library Central Register of Controlled Trials, China national knowledge infrastructure database, Wan fang database, Chongqing VIP information, and SinoMed from their inception to May 2020. Two researchers will select and evaluate qualified studies independently. The bone mineral density value and the incidence of fractures will be accepted as the primary outcomes. The meta-analyses will be performed by using the RevMan 5.3. Results: This study will provide a comprehensive evaluation of the efficacy and safety of BSQG method for patients with POP. Conclusion: The conclusion of our systematic review will provide evidence to judge whether BSQG is an effective intervention for patients with POP.

随着社会老龄化的加剧,膝痹(膝骨关节炎,KOA)的发病率逐年攀升,目前我国对KOA的治疗以药物及外科手术为主,忽略了膝关节周边肌肉组织的治疗,因此基于文献证据制定相关的专家共识,以用于指导临床实践是现阶段亟待解决的焦点、难点问题.本共识主要从“训练康复方式”、“训练强度、频率、疗程”、“随访”、“康复评定”4个方面提出了符合我国骨科特色的肌肉训练康复推荐建议,避免因医生诊疗水平不同导致的医疗资源浪费,实现更好的社会、经济效益.

Abstract Background: Knee osteoarthritis (KOA) is a common progressive joint disorder in old people. Bushen huoxue (BSHX) is a classical method of TCM in treating KOA. However, there is no systematic review related to BSHX for KOA. The purpose of this study is to provide a comprehensive and reliable evaluation of the clinical evidence of BSHX in the treatment of KOA. Methods: We searched relevant studies on BSHX for KOA from the databases of PubMed, Embase, MEDLINE, Cochrane Library Central Register of Controlled Trials, China national knowledge infrastructure database (CNKI), Wan fang database, Chongqing VIP information, and SinoMed from their inception to May 2020. Two researchers will select and evaluate qualified studies independently. The primary outcomes of this review will focus on pain intensity. The meta-analyses will be performed by using the RevMan 5.3. Results: The study will provide a comprehensive evaluation of the efficacy and safety of the BSHX method for patients with KOA. Conclusion: The results of this systematic review will provide evidence to judge whether BSHX is an effective intervention for patients with KOA.

文章介绍许学猛教授对腰椎间盘突出症的发病原因与治疗方法的认识,并介绍“肌骨同治”学术思想及其治疗腰椎间盘突出症的实际运用.许学猛教授认为,腰椎间盘突出症的发病不仅是因为腰椎骨骼发生病变,还跟骨骼周边筋肉组织功能异常有关,因此需要“骨筋肉”并重进行综合评估.治疗方面,强调对腰椎骨骼诊疗的同时,需注重患部周边筋肉组织的防治,及早开展整体治疗,提出“肌骨同治”的疗法.

Abstract Background: Primary osteoporosis (POP) is one of the most common orthopedic diseases with a high risk of fracture. Effective treatment of POP is of great significance to reduce the rate of disability and improve the quality of life. Bushen qianggu (BSQG) is a classical method of TCM in treating POP. However, there is no systematic review related to BSQG for POP. The purpose of this study is to provide a comprehensive and reliable evaluation of the clinical evidence of BSQG in the treatment of POP. Methods and analysis: Relevant randomized controlled trial literature evaluating the effect of BSQG on patients with POP will be obtained by searching the PubMed, Embase, MEDLINE, Cochrane Library Central Register of Controlled Trials, China national knowledge infrastructure database, Wan fang database, Chongqing VIP information, and SinoMed from their inception to May 2020. Two researchers will select and evaluate qualified studies independently. The bone mineral density value and the incidence of fractures will be accepted as the primary outcomes. The meta-analyses will be performed by using the RevMan 5.3. Results: This study will provide a comprehensive evaluation of the efficacy and safety of BSQG method for patients with POP. Conclusion: The conclusion of our systematic review will provide evidence to judge whether BSQG is an effective intervention for patients with POP. Trial registration number: 10.17605/OSF.IO/ZMX3W.

The reliability of MyotonPRO that can monitor the mechanical properties of tissues is still unclear. This study aimed to analyze the within-day inter-operator and between-day intra-operator reliability of MyotonPRO for assessing tone and stiffness of quadriceps femoris and patellar tendon at different knee angles. The tone and stiffness of healthy participants (15 males and 15 females, aged 24.7±1.6 years) in the supine and resting position were measured using the MyotonPRO device. The measurements were quantified at 0°, 30°, 60°, and 90° of knee flexion. The intraclass correlation coefficient (ICC), standard error of measurement (SEM), and minimal detectable change (MDC) were calculated and a Bland-Altman analysis was conducted to estimate reliability. The results indicated excellent inter-operator reliability (ICC > 0.78) and good to excellent intra-operator reliability (ICC > 0.41). The inter-operator SEM measurements ranged between 0.1-0.9 Hz and 3.8-37.9 N/m, and intra-operator SEM ranged between 0.5-1.3 Hz and 7.9-52.0 N/m. The inter-operator MDC ranged between 0.3-2.5 Hz and 10.5-105.1 N/m, and intra-operator SEM ranged between 1.1-3.3 Hz and 21.9-144.1 N/m. The agreement of inter-operator was better than that of intra-operator. The study concluded that MyotonPRO is a reliable device to detect the tone and stiffness of quadriceps femoris and patellar tendon.

癥瘕是困扰女性的常见疾病之一,其症状主要为胞宫结块,时伴小腹胀满、出血等.记录一则原用于治疗虚火血崩症的药方——固本止漏汤治疗癥瘕症的临床验案一则,并通过该病案探讨分析癥瘕的病机与治疗原则以及固本止漏汤的作用机理.

月经后期是妇科常见疾病之一,病机为脏腑功能失常、气血失调、冲任损伤,导致胞宫失于藏泻,治疗原则为虚者补之,实者泻之,寒者温之,痰者化之,滞者行之,调理充任,疏通胞脉以调经.女金丹方出自《韩氏医通》,明代《济阴纲目》又加予评释,是古代治疗女性月经不调、不孕症的名方.

口疮是小儿常见口腔疾病,发病时口腔出现单一或多个溃疡面,伴有不同程度的疼痛等多种全身症状.其发病与脾、胃、心三脏有关,病机主要为心脾积热.中医有多种治疗小儿口疮的方法,整理归纳近10年以中医方法治疗小儿口疮的文献,探讨中医治疗小儿口疮的研究进展.

急性腰扭伤是临床常见的腰痛病之一，多见于青壮年和体力劳动者，常因搬抬重物时姿势不当、用力过猛或忽然转身导致。临床上主要表现为腰部剧痛、活动受限等，若不及时治疗易造成慢性腰损伤，且康复较慢、预后较差。笔者采用电针原始点治疗急性腰扭伤，临床疗效满意，现介绍如下。